gms | German Medical Science

Objective: Cerebral hypoperfusion after subarachnoid hemorrhage (SAH) assessed by an early CT-perfusion measurement correlates with the clinical outcome. Furthermore, many patients suffering from SAH develop a hydrocephalus which needs to be treated with a ventricular-peritoneal shunt device (VPS). The goal of the present study is to assess the impact of an early CT perfusion measurement for predicting the development of a posthemorrhagic hydrocephalus in patients suffering from SAH.

Method: In the present pilot series 50 patients with SAH received an early CT-based perfusion measurement was performed within the first 12 hours after initial bleeding. In all patients the overall mean transit time (MTT), the time to peak (TTP) were calculated. The results were correlated with the development of a hydrocephalus and the requirement to implant a VPS.

Results: Between 11/2009 and 3/2011, 50 patients suffering from SAH underwent an early CTP measurement. Mean age was 54.5 y (31 – 81 y), female : male ratio was 7 : 3. 24 patients suffered from WFNS° 1-3 and 26 from WFNS° 4-5 SAH. 23 patients required a VPS. For those patients required a VPS mean MTT was 4.1s (1.6 – 6.3s; standard deviation, SD: 1.1) and mean TTP 2.7 s (1.4 – 6.1s; SD: 1.1). Mean MTT was 3.8s (1.1 – 5.7s; standard deviation, SD: 1.1) and mean TTP 1.9 s (1 – 4.2s; SD: 0.9) for the patients without a hydrocephalus after SAH. The TTP but not the MTT showed to correlate highly significant with the development of a posthemorrhagic hydrocephalus (p = .007).

Conclusions: The TTP but not the MTT in the early CTP measurement after SAH is reliable parameter for the development of a posthemorrhagic hydrocephalus and the requirement of a VPS.